| NPI | 1164414207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18002584B) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18002584A) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: IN 18002584B) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2024-02-06 |